 Welcome back to EM Ottawa Trauma video. This video will discuss the secondary survey. The secondary survey begins after we have addressed all the components of the primary survey. That is airway, breathing, circulation, disability and exposure. The secondary survey is a head-to-toe physical examination with a focus on trauma. We will now discuss it in detail. First, head and neck. On the face, we look for achemosis around the eyes or behind the ears. Tenderness of the facial bones, the nasal bones and the jaw. We check visual acuity, the eyelids and the globe for injuries. We look into oral cavity for tongue laceration and missing teeth. We look inside ear canals for blood behind the tympanic membranes or foreign bodies. On the scalp, we look for skull fracture, scalp swelling or lacerations. Without the patient moving, we palpate the cervical spine for tenderness or swelling. We also inspect the anterior neck and look for swelling, deformity or lacerations. Next, we return to the chest again. This time, we examine the chest for tenderness, swelling, subcutaneous emphysema and bruising. We look for signs that suggest there might have been restraints such as a seatbell sign as shown here. We listen again to breath sounds and heart sounds. We palpate the clavicles, the ribs and the sternum. Next, we examine the abdomen for again bruising, swelling, tenderness or deformity. This can also be a time for a focused abdominal ultrasound examination to look for free fluid in the abdomen. Next, pelvis. We palpate the pelvis for tenderness, deformity, asymmetry and check for instability. We also look for achemosis, swelling and deformity on the skin. If there is a pelvis fracture, you might feel that the pelvis is unstable. Be careful not to open and close the pelvis repeatedly. Every time it does that, more blood will bleed into the space. We also examine the perineum for lacerations, hematoma or blood in the urethra. If you find blood in the tip of the urethra, we do not insert a catheter, since there might be an undiagnosed urethra injury. Next, extremity. Each extremity is checked for neurovascular status, checking for pulse, motor and sensation. Every joint is checked for swelling and deformity. This is also a good time to note any lacerations that might need to be sutured. Next, the back. The patient's back also needs to be examined. A log roll is performed to move the patient as a whole to examine his back. The entire spine is palpated, noting for swelling, tenderness and stepped deformity. We also inspect the back for lacerations, deformity, swelling or bruising along the sides. A rectal examination is also done to check for high-riding prostate, loss of rectal tone, or the presence of blood. That concludes the secondary survey. Your findings will dictate what investigations your patient should receive. Let's return to our patient. On examination of the abdomen, the patient had swelling and bruising along the top part of the abdomen. A focus ultrasound examination shows this image. In this ultrasound image, this is the liver, this is the kidney. This liver of black here shows free fluid in Morrison's pouch. In the context of his injury, the patient likely had an injury that bled into his abdominal cavity. What should we do with the patient? If the patient is stable, as in if his vitals are normal, we have time to bring him to the CT scanner to characterize the injury further. If the patient is unstable, despite resuscitation by fluid and blood, we will want to involve the surgeon's early to bring him directly into the operating room. This concludes our discussion of the primary and secondary survey in a trauma patient. Please refer to the other video on clinical decision rule for CG head and C spine imaging.